Unveiling the Burden of Human Papillomavirus Infection and Risk Factors among indigenous Women in Mizoram, Northeast India

Unveiling the Burden of Human Papillomavirus Infection and Risk Factors among indigenous Women in Mizoram, Northeast India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unveiling the Burden of Human Papillomavirus Infection and Risk Factors among indigenous Women in Mizoram, Northeast India Zomuanpuii Colney, Gracy Laldinmawii, Sangthang Singson, Vanlalfeli Vanlalfeli, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5795028/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Human Papillomavirus (HPV), a major cause of cervical cancer, poses a significant public health challenge globally, with its burden amplified in regionsamidst limited access to screening and preventive measures . Method: This cross-sectional study investigates the prevalence of HPV infection and its associated risk factors among 1018 women from November 2023 to 2024 in Mizoram, India. The study integrates demographic, lifestyle, and clinical data, including DNA-based HPV genotyping and Pap smear analysis, to provide a comprehensive picture of HPV prevalence. Results: This study screened 1,018 women aged between 20 and 73 years for HPV, with a mean age of 41 years. Findings reveal a 14.9% overall prevalence of HPV infection where most participants were from Mizoram's Aizawl District (78.78%). Betel nut consumption and early sexual debut were key lifestyle factors associated with higher infection risks. Chronic pelvic pain and multiple pregnancies were significant clinical indicators. HPV-16 (26.97%) and HPV-18 (17.11%) were the most prevalent genotypes. About 23.4% exhibited multiple genotype infections. Pap smear results revealed associations with high-grade squamous intraepithelial lesions (p=0.025). Conclusion: The study underscores the importance of tailored public health strategies for high-risk regions like Mizoram. These include promoting HPV vaccination, enhancing screening programs, and addressing socio-cultural practices contributing to infection risks. Comprehensive interventions and awareness campaigns are crucial to mitigate the HPV burden and reducing cervical cancer incidence in this unique socio-demographic context. HPV infection cervical cancer genotypic distribution Mizoram public health strategies Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Human Papillomavirus (HPV) the causative agent for cervical cancer is a significant public health concern globally. HPV is primarily transmitted through sexual contact, that infects both males and females. The majority of the virus's clinical manifestations, ranging from benign warts to malignancies, are caused by epithelial cell infection.[ 1 ] At some time in their life, more than 80% of those who engage in copulation will contract HPV.[ 2 ] There are over 200 different types of HPV, categorized into low-risk and high-risk types based on their potential to cause cancer. Low-risk types (e.g., HPV 6 and 11) are associated with genital warts, while high-risk types (e.g., HPV 16 and 18) are linked to various cancers, most notably cervical cancer.[ 3 , 4 ] Skin-to-skin contact in the genital area can also spread the virus. Non-sexual transmission (e.g., vertical transmission from mother to child during childbirth) is rare but possible.[ 5 ] Young adults who initiate sexual activity at an early age, particularly before the age of 18, or those engaging in relationships with multiple sexual partners, are at the highest risk of acquiring HPV infection. This increased susceptibility is often linked to higher exposure to the virus and immature cervical epithelial cells, which are more prone to infection.[ 6 ] Females tend to have a higher rate of infection compared to males, particularly for types associated with cervical cancer. However, both genders are at risk, and males can also develop HPV-related cancers, such as penile, anal, and oropharyngeal cancers.[ 3 ] The prevalence of HPV infection decreases with age as people become more likely to develop immunity to the virus after initial exposure.[ 7 ] Individuals with weakened immune systems (e.g., those with HIV) are more likely to have persistent HPV infections and develop related cancers.[ 6 ] However, vaccine has been developed, and it has been used for immunization of risk population and young adult.[ 3 , 6 ] On the other hand, routine cervical cancer screening through Pap smears and HPV DNA testing helps detect early signs of infection and prevent progression to cancer.[ 8 ] HPV prevalence in cervical cancer varies globally, with higher rates in regions with limited access to healthcare and cervical cancer screening such as Pap smear.[ 9 ] Nearly all cervical cancer cases are attributed to persistent infections with high-risk HPV types, with HPV-16 and HPV-18 accounting for approximately 70% of cases worldwide. These two genotypes are recognized as the most oncogenic among the high-risk HPV types, contributing a significant burden of cervical cancer in the world.[ 6 ] Other HPV Associated Cancer includes Oropharyngeal cancers, anal cancer, penile cancer vaginal cancer etc.[ 3 ] In Asia, the average HPV prevalence among asymptomatic women with normal cervical cytology was 9.4%, while in Oceania, the prevalence was higher at 30.9%.[ 10 ] According to the World Health Organization, India has high rates of HPV infections and HPV-related cancers, contributing nearly one-quarter of the global burden.[ 11 ] Cervical cancer is the most significant health consequence of HPV which ranks as the second leading cause of female cancer in India with an estimate of about 123,907 new cervical cancer cases diagnosed annually. Cervical cancer is the second most common female cancer in women aged 15 to 44 years in India.[ 12 ] Few Indian studies have stated that the frequency of HPV ranged from 2.3–36.9%. There aren't many community-based studies from India that use Polymerase Chain Reaction (PCR) -based techniques to test sexually active asymptomatic women.[ 13 ] In 2020, India accounted for 24% of all cancers linked to HPV, particularly HPV types 16 and 18 infections were the cause of four of every five cervical cancer cases reported.[ 14 ] Mizoram despite being the second least populated state in India which is in the northeastern region, had the highest cervical cancer incidence in the nation (28/100,000 women between 2012 and 2014), which may be explained by the high HPV prevalence.[ 15 , 16 ] Understanding the epidemiology of HPV in India, especially in regions with distinct socio-demographic profiles such as Mizoram, is essential for devising effective prevention and control strategies. Therefore, this study was conducted to determine the epidemiology of HPV infection and its associated risk factors among the women in Mizoram. METHODOLOGY Methodology: Materials & Method: Study design, Setting and population. The present cross-sectional study was conducted during the period of November 2023 to November 2024 in Viral Research and Diagnostic Laboratory, Department of Microbiology, Zoram Medical College, a tertiary care hospital at Falkawn, Mizoram, India. The Institutional Ethics Committee approved the study No.F.20016/1/18-ZMC/IEC/89. After obtaining approval, the samples were collected from women of the age group (20-73 years) who had visited the Gynaecology Department from public and private hospitals in and around the suburban state of city of Aizawl. Prior to enrolment, participants were asked to sign informed consent and were informed on the potential advantages and disadvantages of the research. Other demographic details such as age, occupation, education, social status, lifestyle, marital status, clinical conditions were obtained based on a questionnaire before the collection of the clinical samples. The present study also includes unmarried women who has presenting signs and symptoms related to the study objectives. Sample collection and processing: Cervical specimens were obtained during pelvic examination by the physicians for consenting individuals. The cervix was examined using Cusco’s speculum for complete visualization. All the specimens were collected using a sterile cervical brush or swab, placed in viral transport medium (VTM) and transported in a cold chain to the Viral Research and Diagnostic Laboratory (VRDL), Falkawn for further investigation. DNA Extraction and HPV Genotyping Cervical specimen collected in VTM were directly used for extracting DNA. Extraction of viral DNA was performed using QIAamp DNA mini kit as per manufacturer’s instructions. The extracted DNA were stored in -20℃ until further testing. In this study qualitative PCR was performed in CFX96 Bio-Rad thermocycler. The sample were first subjected for amplification in 20 reaction volume using the consensus primers MY09 /MY11 [17]and GP5+/GP6+ [18] with a target size of 450bp and 150 bp respectively. All reagents were kept at a constant throughout the protocol, each reaction containing approximately 100-200ng of DNA, 8µl of pre- ready-made 10x PCR master mix (Takara, Shiga, Japan) and 10pmol of each primer was set up for the first PCR cycle. The PCR cycling parameter was conditioned at 5 min of the initial denaturation step at 95℃ followed by 1 min of denaturation at 95℃, 1 min of annealing at 53℃, 1 min of elongation at 72℃ for 30 amplification cycles and finally 4 mins of final extension at 72℃. The amplicons were analysed using 2% agarose gel electrophoresis which was stained with ethidium bromide, observed under UV light, and documented using Biorad GelDoc Go System. The positive HPV samples were genotyped using 20 HPV types including low risk (6, 11) and high risk (16, 18,26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68–73 and 82). The PCR reactions for genotyping was performed with few modifications by Şahiner et. al. [19, 20] Statistical analysis: Descriptive analysis was performed for qualitative assessment in the study. Comparison of HPV-positivity across various explanatory variables was done using simple logistic regression model where the odds ratio was estimated with 95% confidence intervals. The p value <0.05 was considered statistically significant. Cytology report such as pap smear and its association with HPV-positivity was evaluated using chi-square test. All estimates were examined by using IBM SPSS Statistics, version 22. RESULTS Demographic and lifestyle characteristics A total of 1018 female between the age of 20 and 73 years were screened for HPV in this study. The overall enrolment and outcome of the study is presented in figure 1. The mean age of the study participants is 41.01 ± SD 8.833 years, where age group 41-50 years were the highest number of participants contributing up to (35.3%) but was not statistically associated with HPV infection. It was observed that there were significantly more of the study participants (78.78%) from Aizawl District as in Table 2. Few of the participants were from outside the state or even from the neighbouring countries. A total of 152 (14.9%) were found to be HPV-positive in the study. The logistic regression analysis identified that the upper age group 51-60 years had a significant number of HPV DNA positivity but with lower odds than the younger age group (OR: 0.155, 95%, Cl: 0.038-0.632, p=0.009). The socio-demographic and participant characteristic are presented in Table 3. Majority of the participants (93.3%) were married, with 78.5% being housewives and 55% having completed high school education. The government employee has 1.898 times the odds of getting infected with HPV than other occupation which is statistically significant. Betel nut consumption (83.2%) and tobacco chewing (72.8%) were significantly more prevalent among participants compared to smoking (54.3%) or alcohol consumption (36.3%). The consumption of betel nut is highly prevalent and is significantly associated with HPV infection p= 0.038 according to the regression analysis. Clinical characteristics associated with HPV infection. The study indicates that participants presented with a range of clinical characteristics, signs, and symptoms as reported by them which is stated in figure 3. Cervicitis was the most frequently reported clinical or provisional diagnosis, affecting 26.6% of patients followed by abnormal uterine bleeding at 12.9%. The most common symptoms were vaginal discharge, seconded by chronic pelvic pain, which were reported at 14.9% and 13.9% respectively, while only chronic pelvic pain was significantly associated with HPV infection (p=0.002) as shown in Table 3. The participants age at first pregnancy were recorded in groups, about a total of 648 had their first pregnancy at the age between 21-30 years. The number of pregnancies was recorded in groups, ranging from no pregnancies to three or more, with the latter group having the highest count at 674 instances which has a higher chance of getting infected (OR: 0.352 Cl: 0.133-0.928, p= 0.035). Majority of the participants have sexual debut at the age between 21-25 years, nevertheless age range from 21-25 years, 26-30 years and 31 and above are all associated with HPV. The use of different type of contraceptives such as ingestion of oral contraceptives, use of condoms and insertion of copper-T were obtained. Among which ingestion of oral contraceptives count the highest number of 436 and were more likely to be HPV-positive compared to those who did not ingest (OR: 0.604 Cl:0.399-0.915, p=0.017). Another method of cervical screening, the Pap smear, reported the following results: a percentage of samples were categorized as negative for intraepithelial lesion or malignancy (NILM), a percentage showed low-grade squamous intraepithelial lesions (with one case testing positive for HPV), and a percentage were identified as high-grade squamous intraepithelial lesions, with two cases testing positive. Chi-square analysis revealed these findings to be statistically significant (p = 0.025). Prevalence of HPV genotypic distribution One hundred and fifty-two samples that were positive for HPV DNA were further tested for twenty genotypes. The most frequently identified HPV was genotype 16 with a percentage of 26.97% followed by HPV genotype 18 (17.11%). Other HPV types detected are HPV 31 and 33 (7.24%), HPV 35 (6.58%) HPV 26 (5.9%), HPV 52 and 53 (5.26%), HPV 58 and 51 (3.95%), HPV 39,45 and 66 (3.9%), HPV 83(2.6%), HPV 56 and 72 (0.66%). HPV 6 and HPV 68 were not detected. Multiple HPV genotype occurrence (n=35, 23.4 % out of 152) was also observed in the study where the most common combinations were HPV genotype 16 and 18 (28.5% out of 35). DISCUSSION This study contributes to the understanding of human papillomavirus epidemiology of the indigenous women residing in Mizoram. It is influenced by various socio-demographic factors such as lifestyle, dietary habits, cultural practices, and other health risk habits like consumption of betel nut and tobacco (chewing and smoking) and intake of alcohol are potential risks. Although HPV incidence is high in India, comprehensive population-based studies on its prevalence and genotype distribution are scarce. To our knowledge, this study is the first of its kind to investigate the prevalence and genotypic distribution of HPV among the Mizo women in a larger scale. Mizoram is one of the seven northeastern states of India, sharing three state borders with Tripura, Assam and Manipur and two international borders in the west with Bangladesh and east with Myanmar. Its unique socio-cultural and geographic features make it a key area for studies on public health, biodiversity along with other research areas. According to the most recent report of National Cancer Registry Programme, Mizoram has the highest rate of cervical cancer, it was also reported that there was a 2.1% of annual percent change in the state. [ 21 ] The current study population consist of 1018 women with majority falling within the 41–50 years age group. This age group has a higher prevalence of HPV infection which is in align with the global pattern where women of the upper age are more likely to be infected by HPV. This study highlighted significant geographic and occupational trends, with most participants originating from Aizawl District,[ 21 , 22 ] suggesting that urbanization may influence access to healthcare services and participation in screening programs. Additionally, a higher prevalence of HPV was observed among public employees, potentially reflecting the impact of stress, lifestyle factors, or proactive healthcare-seeking behaviour within this occupational group. The consumption of tobacco and betel nut is a common practice and were notably observed that betel nut consumption was significantly associated with HPV infection in our analysis. Tobacco and alcohol increase epithelial permeability, enhancing HPV's ability to infect cells. Moreover, the persistent irritation caused by betel nut chewing intensifies inflammation and creates a favourable environment for HPV-driven malignancies. [ 23 ] A similar study was conducted in the neighbouring states, where it was reported that the alcohol consumption, tobacco chewing and other risk factors were significantly associated with increased risk of HPV infection which aligns with the present study. [ 24 ] Chronic pelvic pain, though non-specific, might signal persistent HPV infection or early cervical pathology. The reproductive history has been shown to influence the risk of HPV infection. Factors such as early age at first sexual intercourse, multiple sexual partners, high parity (number of full-term pregnancies), and contraceptive use are associated with an increased likelihood of HPV acquisition and persistence.[ 22 , 25 ] Women with three or more pregnancies exhibited higher odds of infections indicating that increased parity may weaken cervical tissue and cause affinity to harbour the virus. [ 26 ] Contraceptive practices, especially oral contraceptive (OC) uses are currently one of the most common forms of contraception. It was observed that women who ingested contraceptive pills were more likely to be HPV-positive (OR: 0.604, p = 0.017) in the study. This report is in accordance with existing research suggesting that prolonged use of hormonal contraceptives may alter cervical epithelial cells.[ 27 , 28 ] The study by Delgado- Rodriguez et. al. , comments that the risk increased with duration of OC use which may imply an initiator effect.[ 28 ] A study by Gravitt et. al., reports that the HPV DNA testing is highly sensitive as compared to pap cytology.[ 29 ] While other literature documents that combining these methods enhances the ability to identify both HPV infection and abnormal cervical cells, improving the accuracy of early detection and prevention efforts.[ 30 ] However, in developing countries, the early detection of precancerous lesions often fails despite the use of multiple techniques, leading to many women presenting with advanced stages of the disease. This issue arises from limited access to screening programs, a lack of awareness, and inadequate healthcare infrastructure.[ 22 ] Combination of HPV DNA detection and Pap smear testing was performed in the present study where it was statistically significant. The most prevalent HPV genotype was identified as HPV-16 and HPV-18 in this investigation which mirrors the regional and global dominance of high-risk genotypes in cervical cancer aetiology.[ 31 – 33 ] The coexistence of multiple genotypic infection at a range of 2 to 4 was also observed. Other researchers reports that the multiple genotype infection occurs entirely due to chance, however, it is also largely contributed by sexual behaviour or immunological mechanism.[ 34 ] Documents have shown that the genotypes particularly the combination of HPV-16 and HPV-18 amplify oncogenic potential, warranting further investigation into its clinical implications.[ 35 ] In the current study, certain limitations were acknowledged. Since it is a cross-sectional study, some parameters which require extensive follow-ups were restricted. Furthermore, there are resource limitations especially in low prevalence districts. Despite these limitations, this study represents the first comprehensive investigation into the prevalence of HPV on this relatively understudied part of India, laying the groundwork for future research initiatives in the region. Conclusion The study findings offer valuable insights into HPV epidemiology in Mizoram, in the suburban hilly state of the Northeastern India. It highlights the complex interaction between demographic, lifestyle, and clinical factors in assessing the risk of HPV infection. The significant presence of high-risk HPV genotypes, especially HPV-16 and HPV-18, underlining the necessity for tailored interventions such as effective vaccination and screening programs specific to Mizoram's regional context. Public health initiatives should prioritize addressing cultural practices, enhancing access to cervical cancer prevention services, and raising awareness to alleviate the HPV burden in this high-risk population. Enhanced research and public health efforts could substantially reduce the HPV burden and incidence of cervical cancer in the area. Declarations Conflict of interest: The authors declare no conflict of interest. Author Contribution Z.C. and S.S. analysed the data, data cleaning and drafted the manuscript. Z.C. and S.R. contributed to the conceptualization, investigation, revising of the manuscript. Z.C., S.R., S.S., L.L., L.L., .G.L. and R.L. methodology, and validation and revising of the manuscript of the study. V.V, V.V., Z.C., C.N., L.L, H.V., L.L., L.L. conducted sample and data collection. All authors approved the final manuscript. Acknowledgement Authors acknowledge the VRDL, Zoram Medical College under ICMR- DHR for infrastructure and other supports. 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Indian J Gynecol Oncol 20:. https://doi.org/10.1007/S40944-022-00610-7 Das P, Begum G, Thakur S, Purkait P, Kaur D (2022) A study on high-risk Human Papilloma Virus (HPV) types 16 & 18 infections among the women of the Barak Valley in Northeast India. Antrocom Journal of Anthropology 18:387–395 Chaturvedi AK, Katki HA, Hildesheim A, Rodríguez AC, Quint W, Schiffman M, Van Doorn LJ, Porras C, Wacholder S, Gonzalez P, Sherman ME, Herrero R (2011) Human papillomavirus infection with multiple types: Pattern of coinfection and risk of cervical disease. Journal of Infectious Diseases 203:910–920. https://doi.org/10.1093/infdis/jiq139 Human Papillomavirus (HPV) Infection - Human Papillomaviruses - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK321770/. Accessed 18 Nov 2024 Bauer HM, Ting Y, Greer CE, Chambers JC, Tashiro CJ, Chimera J, Reingold A, Manos ; M Michele, Corp C, Bauer M, Ting G, Manos D Genital Human Papillomavirus Infection in Female University Students as Determined by a PCR-Based Method Chimera) Tables Table 1. Primer sequence used in the study Name Primer Sequence (5'-3') Target size Reference MY09 F: 5′-CGTCCMARRGGAWACTGATC3′ 450bp [36] MY11 G: 5′-GCMCAGGGWCATAAYAATGG-3′ GP5-F F: 5'-TTTGTTACTGTGGTAGATACTAC-3' 149 bp [18] GP6-R G: 5'-GAAAAATAAACTGTAAATCATATTC 3' HPV type 6 F: 5′-GTATCCAARGTTGTTGCCACGGAT-3′ 130bp [19] R: 5′-GCACAACAGTTTTGTTAGCCCG-3′ HPV type 11 F: 5′-GTATCCAARGTTGTTGCCACGGAT-3′ 176bp [19] R: 5′-GGCAACACTACCTTAAACACTCTA-3′ HPV type 16 F: 5′-TGCACGCACAAACATATATTATCATG-3′ 130bp [19] R: 5′-CCTGTATTGTAATCCTGATACTTTAG-3′ HPV type 18 F: 5′-CCAAGTGGCTCTATTGTTACCTC-3′ 130bp [19] R: 5′-GAGTGGTATCTACCACAGTAAC-3′ HPV type 26 F: 5′-CTAGTGACAGCAAGGTATATCTTC-3′ 127bp [20] R: 5′-GGATGTCCTAATGTTAATAAACGAG-3′ HPV type 31 F: 5′-CAGGATATAGGGCACGTCCTA-3′ 159bp [19] R: 5′-CACATATACAATACAGCACAAGCAC-3′ HPV type 33 F: 5′-GTAAGCCTCCAACAGGGGAAC-3′ 132bp [19] R: 5′-CAAATCCTGTGTCCACCATATCAC-3′ HPV type 35 F: 5′-GCACACCTTGTAATGCTAACCAG-3′ 145bp [19] R: 5′-ACATCACTTTTATTAGCTTGTAATGTAG-3′ HPV type 39 F: 5′-GCGAAGGTTGTCAATACTGATG-3′ 127bp [19] R: 5′-CCTGCTTGCGACCACCATTC-3′ HPV type 45 F: 5′-CACTAGCGCTAATATGCGTGAMAC-3′ 175bp [19] R: 5′-GTCCACYACAGTAACAAACAACTG-3′ HPV type 51 F: 5′-CAGACTAATWACATTAGGACATCC-3′ 128bp [20] R: 5′-CAAACTTGTTAGGATCTGGTAACTG-3′ HPV type 52 F: 5′-CTACAGCTCATTAACAGTGTAATAC-3′ 136bp [19] R: 5′-CTGGATACTTACATACACTGCTAC-3′ HPV type 53 F: 5′-GAATATGAATTACAATTTGTGTTTCAACTA-3′ 178bp [20] R: 5′-AGGTTATAGCTGCACTTTTCACATAT-3′ HPV type 56 F: 5′-TCTGAGGCACAGTTATTTAATAAACC-3′ 142bp [20] R: 5′-CTGTAGCAGTACTAATAGTCATGTTAG-3′ HPV type 58 F: 5′-ATGCTTATCTATGGATTATAAACAAACAC-3′ 125bp [19] R: 5′-ATGGAGGACAATCAGTAGCAGCT-3′ HPV type 59 F: 5′-AATACCACTATTTTGGAGGATTGGAA-3′ 163bp [20] R: 5′-CAGGCCAAAACTTTAGTTTGTCATAAG-3′ HPV type 66 F: 5′-CCTCCTCCCAGTTCTGTATATG-3′ 167bp [20] R: 5′-GTRCTTCTGGTAGTATCCACAAC-3′ HPV type 68 F: 5′-CTCTGACTCCCAGTTATTTAACAAG-3′ 149bp [19] R: 5′-TAGAGTCTGTAGTAGTGGACAATG-3′ HPV type 73 F: 5′-ACTGCAACACCATCCAGTTGTG-3′ 173bp [20] R: 5′-GTGCTTCTAGTAGTATCTACAACAG-3′ HPV type 82 F: 5′-GTTATACAAGGTGGGGATTACTA-3′ 144bp [19] R: 5′-GKGACACTGGTGCAGGTGGTA-3′ Table 2 - Participants characteristic and HPV DNA association. (n=1018) Demographic Variables HPV DNA Odds ratio (95% CI) p- value Total N (%) Positive N (%) Negative N (%) Age group (in Years) >20 14 (1.3) 4 (0.3) 10 (0.9) Reference 21-30 95 (9.3) 18 (1.7) 77 (7.5) 0.505 (0.135- 1.885) 0.309 31-40 413 (40.5) 66 (6.4) 347 (34.0) 0.452 (0.113- 1.537) 0.204 41-50 360(35.3) 54 (5.3) 306 (30.0) 0.405 (0.118-1.383) 0.149 51-60 118 (11.5) 8(0.7) 110 (10.8) 0.155 (0.038-0.632) 0.009* <60 18 (1.7) 2(0.1) 16 (1.5) 0.259 (0.038-1.761) 0.167 Occupation Housewife 800(78.5) 108(10.6) 692 (67.9) Reference Unskilled worker 6 (0.5) 2 (0.1) 4 (0.3) 3.740 (0.582- 24.052) 0.165 Business/private 45(4.4) 9 (0.8) 36 (3.5) 1.769 (0.784- 3.991) 0.169 Employed in Government or Public Sector 100 (9.8) 22(2.1) 78(7.6) 1.898 (1.035- 3.480) 0.038* Self employed 67(6.5) 11 (1.0) 56 (5.5) 1.348 (0.658- 2.764) 0.415 Educational Qualification Primary or below 12 (2) 2 (0.1) 10 (0.9) Reference Middle 71 (6.9) 19 (1.8) 52 (5.1) 1.458 (0.256-8.290) 0.671 High 560 (55) 75 (7.3) 485 (47.6) 0.702 (0.139- 3.537) 0.668 Secondary 222 (21.8) 36 (3.5) 186 (18.2) 0.720 (0.141-3.679) 0.693 Graduation 108 (10.6) 15 (1.4) 93 (9.1) 0.521(0.95-2.853) 0.453 Post graduation 45(4.4) 5 (0.4) 40 (3.9) 0.414 (0.063-2.698) 0.356 Marital Status Unmarried 68 (6.6) 10(0.9) 58(5.6) Referencez Married 950 (93.3) 142(13.9) 808(79.3) 0.989 (0.474- 2.064) 0.989 Betel Nut consumption Never 171 (16.7) 19 (1.8) 152 (14.9) Reference Frequent 495 (48.6) 61(5.9) 434 (42.6) 0.615 (0.295- 1.283) 0.195 Moderate 352 (34.5) 72 (7.0) 280 (27.5) 1.847 (1.036- 3.293) 0.038* Smoking Never 465 (45.6) 405 (39.7) 60 (5.8) Reference Frequent 333 (32.7) 287(28.1) 46 (4.5) 1.116 (0.455-2.738) 0.811 Moderate 220 (21.6) 174 (17.0) 46 (4.5) 1.434 (0.887-2.319) 0.141 Chewing tobacco Never 276 (27.1) 237(23.2) 39 (3.8) Reference Frequent 582 (57.1) 499(49.0) 83 (8.1) 1.069 (0.624-1.832) 0.807 Moderate 160 (15.7) 130(12.7) 30 (2.9) 1.159 (0.657- 2.043) 0.610 Alcohol consumption Never 648 (63.6) 94(9.2) 554 (54.4) Reference Frequent 286 (28) 41(4.0) 245 (24.0) 2.182 (0.848-5.616) 0.703 Moderate 84 (8.2) 17(1.6) 67 (6.5) 1.154 (0.552-2.414) 0.322 *Satistically significant ; Cl= Confident interval Table 3 - Clinical Features and reproductive characteristic. (n=1018) Description HPV DNA Odds ratio (95% CI) p- value Total N (%) Negative N (%) Positive N (%) Post Menopausal Bleeding Yes 8 (0.7) 8 (0.7) 0 (0) No 1010 (99.2) 858 (84.2) 152 (14.9) Vaginal Discharge Yes 152 (14.9) 97 (9.5) 55 (5.4) 1.093 (0.732-1.633) 0.664 No 866 (85.0) 557 (54.7) 309 (30) Reference Cervicitis Yes 271 (26.6) 240 (23.5) 31 (3.0) 0.841 (0.532-1.328) 0.457 No 747(73.3) 626 (61.4) 121 (11.8) Reference Cervics Polyps Yes 23 (2.2) 19(1.8) 4 (0.3) 1.465 (0.458-4.689) 0.520 No 995 (97.7) 847(83.2) 148 (14.5) Reference Borderline Ovarian Tumor Yes 26 (2.5) 23 (2.2) 3(0.2) 1.192 (0.337-4.215) 0.785 No 992(97.4) 843(82.8) 149 (14.6) Reference Visual Inspection with Acetic Acid Yes 22(2.1) 19(1.8) 3 (0.2) 1.479 (0.371-5.897) 0.579 No 996(97.8) 847 (83.2) 149 (14.6) Reference Ovarian Cyst Yes 22 (2.1) 22(2.1) 0 (0) No 996 (97.8) 844(82.9) 152(14.9) Adenomyosis Yes 32 (3.1) 30 (2.9) 2 (0.1) 0.525 (0.119- 2.319) 0.395 No 986 (96.8) 836 (82.1) 150 (14.7) Reference Abnormal Uterus bleeding Yes 132 (12.9) 118(11.5) 14 (1.3) 0.841 (0.439-1.609) 0.600 No 886 (87.0) 748(73.4) 138(13.5) Reference Chronic Pelvic pain Yes 142(13.9) 107(10.5) 35 (3.4) 2.112 (1.315-3.392) 0.002* No 874 (85.8) 759(74.5) 117 (11.4) Reference Menorrhagia Yes 48 (4.7) 40(3.9) 8 (0.7) 1.381 (0.563-3.385) 0.480 No 970 (95.2) 826 (81.1) 144 (14.1) Reference Genital Ulcer Yes 9(0.8) 6 (0.5) 3 (0.2) 4.336 (0.814-23.107) 0.086 No 1009 (99.1) 860(84.4) 149 (14.6) Reference Dyspareunia Yes 22(2.1) 18 (1.7) 4 (0.3) 1.388 (0.417-4.623) 0.593 No 996(97.8) 848(83.3) 148 (14.5) Reference Poscoital bleeing Yes 14(1.3) 11(1.0) 3 (0.2) 1.815(0.430-7.663) 0.417 No 1004(98.6) 855(83.9) 149(14.6) Reference Sexually Transmitted Disease Yes 7 (0.6) 6(0.5) 1(0.0) 1.060 (0.115-9.803) 0.959 No 1011 (99.3) 860(84.4) 151(14.8) Reference Hypertension Yes 39(3.8) 31(3.0) 8(0.7) 1.317(0.554-3.133) 0.533 No 979 (96.1) 835(82.0) 144(14.1) Reference Diabetes Yes 81 (7.9) 71(6.9) 10(0.9) 1.130 (0.501-2.549) 0.769 No 937(92.0) 795(78.0) 142(13.9) Reference Thyroid disorder Yes 22 (2.1) 18(1.7) 4(0.3) 1.962 (0.596-6.456) 0.267 No 996 (97.8) 848(83.3) 148(14.5) Reference Age at first pregnancy in group Nulligravida 15 (1.4) 15(1.4) 0(0) 30 years 104(10.2) 92(9.0) 12(1.1) Number of pregnancy in group No pregnancy 36(3.5) 29(2.8) 7(0.6) Reference Only 1 123(12.0) 101(9.9) 22(2.1) 0.496 (0.173-1.418) 0.191 Only 2 185 (18.5) 153(15.0) 32(3.1) 0.503 (0.182-1.388) 0.185 3 or more pregancy 674(66.2) 583 (57.2) 91(8.9) 0.352 (0.133-0.928) 0.035* Age of first intercourse in groups Less than 15 years 53 (5.2) 38(3.7) 15(1.4) Reference 16 to 20 years 216 (21.2) 176(17.2) 40(3.9) 0.497 (0.229- 1.077) 0.076 21 to 25 years 469(46.0) 411(40.3) 58(5.6) 0.313 (0.137- 0.714) 0.006* 26 to 30 years 169 (16.6) 142(13.9) 27(2.6) 0.315 (0.123-0.804) 0.016* 31 years and above 111 (10.9) 99(9.7) 12(1.1) 0.268 (0.08- 0.871) 0.029* Number of sexual partner One person 906 (88.9) 773(75.9) 133(13.0) Reference More than one 112(11.0) 93(9.1) 19(1.8) 1.422 (0.788-2.568) 0.243 Ingestion of contraceptive pills Yes 436 (42.8) 387(38.0) 48 (4.7) 0.604 (0.399-0.915) 0.017* No 583(57.2) 479(47.0) 103(10.11) Reference Use of Condom Yes 18(1.7) 15(1.4) 4(0.39) 0.736 (0.208-2.599) 0.634 No 999(98.1) 851(83.5) 148 (14.5) Reference Use of Copper-T/Intrauterine Device (IUD) Yes 37 (3.6) 31(3.0) 6(0.5) 1.015 (0.395-2.609) 0.976 No 981 (96.3) 835(82.0) 146(14.3) Reference *Satistically significant ; Cl= Confident interval Additional Declarations No competing interests reported. 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09:23:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5795028/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5795028/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73702296,"identity":"6067e588-2f2f-4528-acb6-326f385d0b23","added_by":"auto","created_at":"2025-01-13 17:33:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56714,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart for the enrolled cases for HPV epidemiology\u003c/p\u003e\n\u003cp\u003e*Low-risk HPV types 6/11\u003c/p\u003e\n\u003cp\u003e**High-risk HPV types 16, 18,26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68–73 and 82\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5795028/v1/c4d0fa50c755548a5d514e01.png"},{"id":73702298,"identity":"33ca1e97-7bd0-4952-86af-cbc4bb0e0810","added_by":"auto","created_at":"2025-01-13 17:33:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":336998,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of HPV-DNA Positivity from District of Mizoram\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5795028/v1/a3e29b9b0db704e370ac3b7a.png"},{"id":73702292,"identity":"8bf9f5d0-79cb-4899-bdef-b81ce1deabb8","added_by":"auto","created_at":"2025-01-13 17:33:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":54305,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage distribution of clinical characteristics of HPV in the study\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5795028/v1/9ad264b90bae7ac609a9ef81.png"},{"id":73728964,"identity":"f736bf62-1b93-47d0-a4d4-b0a1f18f97ea","added_by":"auto","created_at":"2025-01-14 04:53:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1623997,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5795028/v1/3063d121-3d7b-42a0-b3b2-6b7014f65f8f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unveiling the Burden of Human Papillomavirus Infection and Risk Factors among indigenous Women in Mizoram, Northeast India","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHuman Papillomavirus (HPV) the causative agent for cervical cancer is a significant public health concern globally. HPV is primarily transmitted through sexual contact, that infects both males and females. The majority of the virus's clinical manifestations, ranging from benign warts to malignancies, are caused by epithelial cell infection.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] At some time in their life, more than 80% of those who engage in copulation will contract HPV.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] There are over 200 different types of HPV, categorized into low-risk and high-risk types based on their potential to cause cancer. Low-risk types (e.g., HPV 6 and 11) are associated with genital warts, while high-risk types (e.g., HPV 16 and 18) are linked to various cancers, most notably cervical cancer.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSkin-to-skin contact in the genital area can also spread the virus. Non-sexual transmission (e.g., vertical transmission from mother to child during childbirth) is rare but possible.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Young adults who initiate sexual activity at an early age, particularly before the age of 18, or those engaging in relationships with multiple sexual partners, are at the highest risk of acquiring HPV infection. This increased susceptibility is often linked to higher exposure to the virus and immature cervical epithelial cells, which are more prone to infection.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Females tend to have a higher rate of infection compared to males, particularly for types associated with cervical cancer. However, both genders are at risk, and males can also develop HPV-related cancers, such as penile, anal, and oropharyngeal cancers.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] The prevalence of HPV infection decreases with age as people become more likely to develop immunity to the virus after initial exposure.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Individuals with weakened immune systems (e.g., those with HIV) are more likely to have persistent HPV infections and develop related cancers.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] However, vaccine has been developed, and it has been used for immunization of risk population and young adult.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] On the other hand, routine cervical cancer screening through Pap smears and HPV DNA testing helps detect early signs of infection and prevent progression to cancer.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHPV prevalence in cervical cancer varies globally, with higher rates in regions with limited access to healthcare and cervical cancer screening such as Pap smear.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Nearly all cervical cancer cases are attributed to persistent infections with high-risk HPV types, with HPV-16 and HPV-18 accounting for approximately 70% of cases worldwide. These two genotypes are recognized as the most oncogenic among the high-risk HPV types, contributing a significant burden of cervical cancer in the world.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Other HPV Associated Cancer includes Oropharyngeal cancers, anal cancer, penile cancer vaginal cancer etc.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn Asia, the average HPV prevalence among asymptomatic women with normal cervical cytology was 9.4%, while in Oceania, the prevalence was higher at 30.9%.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] According to the World Health Organization, India has high rates of HPV infections and HPV-related cancers, contributing nearly one-quarter of the global burden.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Cervical cancer is the most significant health consequence of HPV which ranks as the second leading cause of female cancer in India with an estimate of about 123,907 new cervical cancer cases diagnosed annually. Cervical cancer is the second most common female cancer in women aged 15 to 44 years in India.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Few Indian studies have stated that the frequency of HPV ranged from 2.3\u0026ndash;36.9%. There aren't many community-based studies from India that use Polymerase Chain Reaction (PCR) -based techniques to test sexually active asymptomatic women.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] In 2020, India accounted for 24% of all cancers linked to HPV, particularly HPV types 16 and 18 infections were the cause of four of every five cervical cancer cases reported.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Mizoram despite being the second least populated state in India which is in the northeastern region, had the highest cervical cancer incidence in the nation (28/100,000 women between 2012 and 2014), which may be explained by the high HPV prevalence.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eUnderstanding the epidemiology of HPV in India, especially in regions with distinct socio-demographic profiles such as Mizoram, is essential for devising effective prevention and control strategies. Therefore, this study was conducted to determine the epidemiology of HPV infection and its associated risk factors among the women in Mizoram.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials \u0026amp; Method:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design, Setting and population.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present cross-sectional study was conducted during the period of\u0026nbsp;November 2023 to November 2024 in Viral Research and Diagnostic Laboratory, Department of Microbiology, Zoram Medical College, a tertiary care hospital at Falkawn, Mizoram, India. The Institutional Ethics Committee approved the study No.F.20016/1/18-ZMC/IEC/89. After obtaining approval, the samples were collected from women of the age group (20-73 years) who had visited the Gynaecology Department from public and private hospitals in and around the suburban state of city of Aizawl. Prior to enrolment, participants were asked to sign informed consent and were informed on the potential advantages and disadvantages of the research. Other demographic details such as age, occupation, education, social status, lifestyle, marital status, clinical conditions were obtained based on a questionnaire before the collection of the clinical samples. The present study also includes unmarried women who has presenting signs and symptoms related to the study objectives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample collection and processing:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCervical specimens were obtained during pelvic examination by the physicians for consenting\u0026nbsp;individuals. \u0026nbsp;The cervix was examined using Cusco\u0026rsquo;s speculum for complete visualization. All the specimens\u0026nbsp;were\u0026nbsp;collected using a sterile cervical brush or swab,\u0026nbsp;placed in viral transport medium\u0026nbsp;(VTM) and\u0026nbsp;transported in a cold chain to the Viral Research and Diagnostic Laboratory (VRDL), Falkawn for further investigation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDNA Extraction and HPV Genotyping\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCervical specimen collected in VTM were directly used for extracting DNA. Extraction of viral DNA was performed using QIAamp DNA mini kit as per manufacturer\u0026rsquo;s instructions. The extracted DNA were stored in -20℃ until further testing.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eIn this study qualitative PCR was performed in CFX96 Bio-Rad\u0026nbsp;thermocycler. The sample were first subjected for amplification in 20 reaction volume using the consensus primers MY09 /MY11 [17]and GP5+/GP6+ [18] with a target size of 450bp and 150 bp respectively. All reagents were kept at a constant\u0026nbsp;throughout the protocol, each reaction containing approximately 100-200ng of DNA, 8\u0026micro;l of pre- ready-made 10x PCR master mix (Takara, Shiga, Japan) and 10pmol of each primer was set up for the first PCR cycle. The PCR cycling parameter was conditioned at 5 min of the initial denaturation step at 95℃ followed by 1 min of denaturation at 95℃, 1 min of annealing at 53℃, 1 min of elongation at 72℃ for 30 amplification cycles and finally 4 mins of final extension at 72℃. The amplicons were analysed using 2% agarose gel electrophoresis which was stained with ethidium bromide, observed under UV light, and documented using Biorad GelDoc Go System.\u003c/p\u003e\n\u003cp\u003eThe positive HPV samples were genotyped using 20 HPV types including low risk (6, 11) and high risk (16, 18,26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68\u0026ndash;73 and 82). The PCR reactions for genotyping was performed with few modifications by Şahiner \u003cem\u003eet. al.\u003c/em\u003e [19, 20]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive analysis was performed for qualitative assessment in the study. Comparison of HPV-positivity across various explanatory variables was done using simple logistic regression model where the odds ratio was estimated with 95% confidence intervals. The p value \u0026lt;0.05 was considered statistically significant. Cytology report such as pap smear and its association with HPV-positivity was evaluated using chi-square test. All estimates were examined by using IBM SPSS Statistics, version 22.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eDemographic and lifestyle characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 1018 female between the age of 20 and 73 years were screened for HPV in this study. The overall enrolment and outcome of the study is presented in figure 1. The mean age of the study participants is 41.01 \u0026plusmn; SD 8.833 years, where age group 41-50 years were the highest number of participants contributing up to (35.3%) but was not statistically associated with HPV infection. It was observed that there were significantly more of the study participants (78.78%) from Aizawl District as in Table 2. Few of the participants were from outside the state or even from the neighbouring countries. A total of 152 (14.9%) were found to be HPV-positive in the study. The logistic regression analysis identified that the upper age group 51-60 years had a significant number of HPV DNA positivity but with lower odds than the younger age group (OR: 0.155, 95%, Cl: 0.038-0.632, p=0.009). The socio-demographic and participant characteristic are presented in Table 3. Majority of the participants (93.3%) were married, with 78.5% being housewives and 55% having completed high school education. The government employee has 1.898 times the odds of getting infected with HPV than other occupation which is statistically significant. Betel nut consumption (83.2%) and tobacco chewing (72.8%) were significantly more prevalent among participants compared to smoking (54.3%) or alcohol consumption (36.3%). The consumption of betel nut is highly prevalent and is significantly associated with HPV infection p= 0.038 according to the regression analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical characteristics associated with HPV infection.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study indicates that participants presented with a range of clinical characteristics, signs, and symptoms as reported by them which is stated in figure 3. Cervicitis was the most frequently reported clinical or provisional diagnosis, affecting 26.6% of patients followed by abnormal uterine bleeding at 12.9%. The most common symptoms were vaginal discharge, seconded by chronic pelvic pain, which were reported at 14.9% and 13.9% respectively, while only chronic pelvic pain was significantly associated with HPV infection (p=0.002) as shown in Table 3. The participants age at first pregnancy were recorded in groups, about a total of 648 had their first pregnancy at the age between 21-30 years. The number of pregnancies was recorded in groups, ranging from no pregnancies to three or more, with the latter group having the highest count at 674 instances which has a higher chance of getting infected (OR: 0.352 Cl: 0.133-0.928, p= 0.035). Majority of the participants have sexual debut at the age between 21-25 years, nevertheless age range from 21-25 years, 26-30 years and 31 and above are all associated with HPV. The use of different type of contraceptives such as ingestion of oral contraceptives, use of condoms and insertion of copper-T were obtained. Among which ingestion of oral contraceptives count the highest number of 436 and were more likely to be HPV-positive compared to those who did not ingest (OR: 0.604 Cl:0.399-0.915, p=0.017). \u0026nbsp;Another method of cervical screening, the Pap smear, reported the following results: a percentage of samples were categorized as negative for intraepithelial lesion or malignancy (NILM), a percentage showed low-grade squamous intraepithelial lesions (with one case testing positive for HPV), and a percentage were identified as high-grade squamous intraepithelial lesions, with two cases testing positive. Chi-square analysis revealed these findings to be statistically significant (p = 0.025).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of HPV genotypic distribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne hundred and fifty-two samples that were positive for HPV DNA were further tested for twenty genotypes. The most frequently identified HPV was genotype 16 with a percentage of 26.97% followed by HPV genotype 18 (17.11%). Other HPV types detected are HPV 31 and 33 (7.24%), HPV 35 (6.58%) HPV 26 (5.9%), HPV 52 and 53 (5.26%), HPV 58 and 51 (3.95%), HPV 39,45 and 66 (3.9%), HPV 83(2.6%), HPV 56 and 72 (0.66%). HPV 6 and HPV 68 were not detected. Multiple HPV genotype occurrence (n=35, 23.4 % out of 152) was also observed in the study where the most common combinations were HPV genotype 16 and 18 (28.5% out of 35).\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study contributes to the understanding of human papillomavirus epidemiology of the indigenous women residing in Mizoram. It is influenced by various socio-demographic factors such as lifestyle, dietary habits, cultural practices, and other health risk habits like consumption of betel nut and tobacco (chewing and smoking) and intake of alcohol are potential risks. Although HPV incidence is high in India, comprehensive population-based studies on its prevalence and genotype distribution are scarce. To our knowledge, this study is the first of its kind to investigate the prevalence and genotypic distribution of HPV among the Mizo women in a larger scale. Mizoram is one of the seven northeastern states of India, sharing three state borders with Tripura, Assam and Manipur and two international borders in the west with Bangladesh and east with Myanmar. Its unique socio-cultural and geographic features make it a key area for studies on public health, biodiversity along with other research areas.\u003c/p\u003e \u003cp\u003eAccording to the most recent report of National Cancer Registry Programme, Mizoram has the highest rate of cervical cancer, it was also reported that there was a 2.1% of annual percent change in the state. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] The current study population consist of 1018 women with majority falling within the 41\u0026ndash;50 years age group. This age group has a higher prevalence of HPV infection which is in align with the global pattern where women of the upper age are more likely to be infected by HPV. This study highlighted significant geographic and occupational trends, with most participants originating from Aizawl District,[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] suggesting that urbanization may influence access to healthcare services and participation in screening programs. Additionally, a higher prevalence of HPV was observed among public employees, potentially reflecting the impact of stress, lifestyle factors, or proactive healthcare-seeking behaviour within this occupational group.\u003c/p\u003e \u003cp\u003eThe consumption of tobacco and betel nut is a common practice and were notably observed that betel nut consumption was significantly associated with HPV infection in our analysis. Tobacco and alcohol increase epithelial permeability, enhancing HPV's ability to infect cells. Moreover, the persistent irritation caused by betel nut chewing intensifies inflammation and creates a favourable environment for HPV-driven malignancies. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] A similar study was conducted in the neighbouring states, where it was reported that the alcohol consumption, tobacco chewing and other risk factors were significantly associated with increased risk of HPV infection which aligns with the present study. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eChronic pelvic pain, though non-specific, might signal persistent HPV infection or early cervical pathology. The reproductive history has been shown to influence the risk of HPV infection. Factors such as early age at first sexual intercourse, multiple sexual partners, high parity (number of full-term pregnancies), and contraceptive use are associated with an increased likelihood of HPV acquisition and persistence.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] Women with three or more pregnancies exhibited higher odds of infections indicating that increased parity may weaken cervical tissue and cause affinity to harbour the virus. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eContraceptive practices, especially oral contraceptive (OC) uses are currently one of the most common forms of contraception. It was observed that women who ingested contraceptive pills were more likely to be HPV-positive (OR: 0.604, p\u0026thinsp;=\u0026thinsp;0.017) in the study. This report is in accordance with existing research suggesting that prolonged use of hormonal contraceptives may alter cervical epithelial cells.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] The study by Delgado- Rodriguez \u003cem\u003eet. al.\u003c/em\u003e, comments that the risk increased with duration of OC use which may imply an initiator effect.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eA study by Gravitt \u003cem\u003eet.\u003c/em\u003e al., reports that the HPV DNA testing is highly sensitive as compared to pap cytology.[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] While other literature documents that combining these methods enhances the ability to identify both HPV infection and abnormal cervical cells, improving the accuracy of early detection and prevention efforts.[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] However, in developing countries, the early detection of precancerous lesions often fails despite the use of multiple techniques, leading to many women presenting with advanced stages of the disease. This issue arises from limited access to screening programs, a lack of awareness, and inadequate healthcare infrastructure.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Combination of HPV DNA detection and Pap smear testing was performed in the present study where it was statistically significant.\u003c/p\u003e \u003cp\u003eThe most prevalent HPV genotype was identified as HPV-16 and HPV-18 in this investigation which mirrors the regional and global dominance of high-risk genotypes in cervical cancer aetiology.[\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] The coexistence of multiple genotypic infection at a range of 2 to 4 was also observed. Other researchers reports that the multiple genotype infection occurs entirely due to chance, however, it is also largely contributed by sexual behaviour or immunological mechanism.[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] Documents have shown that the genotypes particularly the combination of HPV-16 and HPV-18 amplify oncogenic potential, warranting further investigation into its clinical implications.[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn the current study, certain limitations were acknowledged. Since it is a cross-sectional study, some parameters which require extensive follow-ups were restricted. Furthermore, there are resource limitations especially in low prevalence districts. Despite these limitations, this study represents the first comprehensive investigation into the prevalence of HPV on this relatively understudied part of India, laying the groundwork for future research initiatives in the region.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study findings offer valuable insights into HPV epidemiology in Mizoram, in the suburban hilly state of the Northeastern India. It highlights the complex interaction between demographic, lifestyle, and clinical factors in assessing the risk of HPV infection. The significant presence of high-risk HPV genotypes, especially HPV-16 and HPV-18, underlining the necessity for tailored interventions such as effective vaccination and screening programs specific to Mizoram's regional context. Public health initiatives should prioritize addressing cultural practices, enhancing access to cervical cancer prevention services, and raising awareness to alleviate the HPV burden in this high-risk population. Enhanced research and public health efforts could substantially reduce the HPV burden and incidence of cervical cancer in the area.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of interest:\u003c/h2\u003e \u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eZ.C. and S.S. analysed the data, data cleaning and drafted the manuscript. Z.C. and S.R. contributed to the conceptualization, investigation, revising of the manuscript. Z.C., S.R., S.S., L.L., L.L., .G.L. and R.L. methodology, and validation and revising of the manuscript of the study. V.V, V.V., Z.C., C.N., L.L, H.V., L.L., L.L. conducted sample and data collection. All authors approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eAuthors acknowledge the VRDL, Zoram Medical College under ICMR- DHR for infrastructure and other supports. Authors also appreciate and acknowledge the healthcare staff who helped to collect data at their health centres.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNtanasis-Stathopoulos I, Kyriazoglou A, Liontos M, A Dimopoulos M, Gavriatopoulou M (2020) Current trends in the management and prevention of human papillomavirus (HPV) infection. J BUON 25:1281\u0026ndash;1285\u003c/li\u003e\n\u003cli\u003eUNICEF Europe and Central Asia (2024) What to know about HPV vaccination. https://www.unicef.org/eca/stories/what-know-about-hpv-vaccination. Accessed 25 Oct 2024\u003c/li\u003e\n\u003cli\u003eNational Cancer Institute (2023) HPV and Cancer - NCI. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer. Accessed 25 Oct 2024\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (2024) Human papillomavirus and cancer. https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer. 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The Lancet Regional Health - Southeast Asia 17:. https://doi.org/10.1016/j.lansea.2023.100281\u003c/li\u003e\n\u003cli\u003eMuwonge R, Basu P, Gheit T, Anantharaman D, Verma Y, Bhatla N, Joshi S, Esmy PO, Poli URR, Shah A, Zomawia E, Shastri SS, Pimple S, Prabhu PR, Hingmire S, Chiwate A, Sauvaget C, Lucas E, Malvi SG, Siddiqi M, Sankaran S, Kannan TPRA, Varghese R, Divate U, Vashist S, Mishra G, Jadhav R, Tommasino M, Pillai MR, Sankaranarayanan R, Jayant K, Shah A, Esmy PO, Anilkumar D, Kavitha M, Umarani P, Malvi SG, Jayant K, Hingmire S, Chiwate A, Poli URR, Poojari R, Varija Y, Sujatha M, Siddiqi M, Zomawia E, Mishra G, Bhatla N, Vashist S, Joshi S, Divate U, Jadhav R, Gupta A, Thatal A, Deokota RN, Pillai MR, Anantharaman D, Prabhu PR, Sankaran S, Kairnnan A, Varghese R, Basu P, Muwonge R, Gheit T, Sauvaget C, Lucas E, Tommasino M, Sankaranarayanan R (2020) Acquisition, prevalence and clearance of typespecific human papillomavirus infections in young sexually active Indian women: A community-based multicentric cohort study. PLoS One 15:. https://doi.org/10.1371/journal.pone.0244242\u003c/li\u003e\n\u003cli\u003eBauer HM, Ting Y, Greer CE, Chambers JC, Tashiro CJ, Chimera J, Reingold A, Manos ; M Michele, Corp C, Bauer M, Ting G, Manos D Genital Human Papillomavirus Infection in Female University Students as Determined by a PCR-Based Method Chimera)\u003c/li\u003e\n\u003cli\u003eJiang G, Cruz Y, Jen Chang C, F Ho GY, Klein RS, Burk RD (1997) PCR Detection of Human Papillomavirus: Comparison between MY09/MY11 and GP5/GP6 Primer Systems\u003c/li\u003e\n\u003cli\u003eŞahiner F, Kubar A, G\u0026uuml;mral R, Ardi\u0026ccedil; M, Yiğit N, Şener K, Dede M, Yapar M (2014) Efficiency of MY09/11 consensus PCR in the detection of multiple HPV infections. Diagn Microbiol Infect Dis 80:43\u0026ndash;49. https://doi.org/10.1016/j.diagmicrobio.2014.03.030\u003c/li\u003e\n\u003cli\u003eSahiner F, Kubar A, Yapar M, Sener K, Dede M, G\u0026uuml;mral R (2014) Detection of major HPVs by a new multiplex real-time PCR assay using type-specific primers. J Microbiol Methods 97:44\u0026ndash;50. https://doi.org/10.1016/j.mimet.2013.12.012\u003c/li\u003e\n\u003cli\u003eNational Centre for Disease Informatics and Research (2012) Report of National Cancer RegistryProgramme. https://ncdirindia.org/All_Reports/Report_2020/resources/AInitialPages.pdfAccessed: 2024-12-23\u003c/li\u003e\n\u003cli\u003eSreedevi A, Javed R, Dinesh A (2015) Epidemiology of cervical cancer with special focus on India. Int J Womens Health 7:405. https://doi.org/10.2147/IJWH.S50001\u003c/li\u003e\n\u003cli\u003eKumar R, Kumar Rai A, Das D, Das R, Suresh Kumar R, Sarma A, Sharma S, Kataki AC, Ramteke A (2015) Alcohol and Tobacco Increases Risk of High Risk HPV Infection in Head and Neck Cancer Patients: Study from North-East Region of India. https://doi.org/10.1371/journal.pone.0140700\u003c/li\u003e\n\u003cli\u003eBarmon D, Sarma A, Baruah U, Kakoti L, Barman D, Sarma P, Kalita M, Rai AK (2023) Association of Abnormal Cytology and risk factors in Women of Assam, India\u003c/li\u003e\n\u003cli\u003eRamamoorthy T, Sathishkumar K, Das P, Sudarshan KL, Mathur P (2022) Epidemiology of human papillomavirus related cancers in India: findings from the National Cancer Registry Programme. Ecancermedicalscience 16:. https://doi.org/10.3332/ecancer.2022.1444\u003c/li\u003e\n\u003cli\u003eBhattacharya A, Chakraborty K, Saha P, Saha S, Roychaudhuri P, Baidya JL, Ghosh A, Chakraborty D, Sengupta S, Sil SK (2024) Cervical cytology abnormalities and associated genotype patterns of High-Risk HPV Infection in Women of Tripura, North-East India: A Hospital-Based Study. Am J Epidemiol. https://doi.org/10.1093/AJE/KWAE364\u003c/li\u003e\n\u003cli\u003eMoreno V, Bosch FX, Mu\u0026ntilde;oz N, Meijer CJLM, Shah K V., Walboomers JMM, Herrero R, Franceschi S (2002) Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: The IARC multicentric case-control study. Lancet 359:1085\u0026ndash;1092. https://doi.org/10.1016/S0140-6736(02)08150-3\u003c/li\u003e\n\u003cli\u003eDelgado‐Rodriguez M, Sillero‐Arenas M, Martin‐Moreno JM, Galvez‐Vargas R (1992) Oral contraceptives and cancer of the cervix uteri: A meta‐analysis. Acta Obstet Gynecol Scand 71:368\u0026ndash;376. https://doi.org/10.3109/00016349209021075\u003c/li\u003e\n\u003cli\u003eGravitt PE, Paul P, Katki HA, Vendantham H, Ramakrishna G, Sudula M, Kalpana B, Ronnett BM, Vijayaraghavan K, Shah KS (2010) Effectiveness of VIA, Pap, and HPV DNA Testing in a Cervical Cancer Screening Program in a Peri-Urban Community in Andhra Pradesh, India. PLoS One 5:e13711. https://doi.org/10.1371/JOURNAL.PONE.0013711\u003c/li\u003e\n\u003cli\u003eMoarcăs M, Georgescu IC, Brătilă E, Badea M, C\u0026icirc;rstoiu M (2014) Clinical significance of HPV-DNA testing for precancerous cervical lesionS. J Med Life 7:37\u003c/li\u003e\n\u003cli\u003eCervical Cancer Causes, Risk Factors, and Prevention - NCI. https://www.cancer.gov/types/cervical/causes-risk-prevention. Accessed 13 Nov 2024\u003c/li\u003e\n\u003cli\u003eSailo CV, Zami Z, Ghatak S, Nemi L, Lalremmawia K, Pachuau L, Zomawia E, Siama Z, Kumar NS (2022) Prevalence of High-Risk HPV Types in Women with Negative Cervical Cytology in a State of Northeast India with a High Burden of Cervical Cancer. Indian J Gynecol Oncol 20:. https://doi.org/10.1007/S40944-022-00610-7\u003c/li\u003e\n\u003cli\u003eDas P, Begum G, Thakur S, Purkait P, Kaur D (2022) A study on high-risk Human Papilloma Virus (HPV) types 16 \u0026amp; 18 infections among the women of the Barak Valley in Northeast India. Antrocom Journal of Anthropology 18:387\u0026ndash;395\u003c/li\u003e\n\u003cli\u003eChaturvedi AK, Katki HA, Hildesheim A, Rodr\u0026iacute;guez AC, Quint W, Schiffman M, Van Doorn LJ, Porras C, Wacholder S, Gonzalez P, Sherman ME, Herrero R (2011) Human papillomavirus infection with multiple types: Pattern of coinfection and risk of cervical disease. Journal of Infectious Diseases 203:910\u0026ndash;920. https://doi.org/10.1093/infdis/jiq139\u003c/li\u003e\n\u003cli\u003eHuman Papillomavirus (HPV) Infection - Human Papillomaviruses - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK321770/. Accessed 18 Nov 2024\u003c/li\u003e\n\u003cli\u003eBauer HM, Ting Y, Greer CE, Chambers JC, Tashiro CJ, Chimera J, Reingold A, Manos ; M Michele, Corp C, Bauer M, Ting G, Manos D Genital Human Papillomavirus Infection in Female University Students as Determined by a PCR-Based Method Chimera)\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Primer sequence used in the study\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eName Primer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSequence (5\u0026apos;-3\u0026apos;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTarget size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eMY09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-CGTCCMARRGGAWACTGATC3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e450bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[36]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eMY11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eG: 5\u0026prime;-GCMCAGGGWCATAAYAATGG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eGP5-F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026apos;-TTTGTTACTGTGGTAGATACTAC-3\u0026apos;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e149 bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[18]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eGP6-R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eG: 5\u0026apos;-GAAAAATAAACTGTAAATCATATTC 3\u0026apos;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-GTATCCAARGTTGTTGCCACGGAT-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e130bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-GCACAACAGTTTTGTTAGCCCG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-GTATCCAARGTTGTTGCCACGGAT-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e176bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-GGCAACACTACCTTAAACACTCTA-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-TGCACGCACAAACATATATTATCATG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e130bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-CCTGTATTGTAATCCTGATACTTTAG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-CCAAGTGGCTCTATTGTTACCTC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e130bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-GAGTGGTATCTACCACAGTAAC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-CTAGTGACAGCAAGGTATATCTTC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e127bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[20]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-GGATGTCCTAATGTTAATAAACGAG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-CAGGATATAGGGCACGTCCTA-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e159bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-CACATATACAATACAGCACAAGCAC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-GTAAGCCTCCAACAGGGGAAC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e132bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-CAAATCCTGTGTCCACCATATCAC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-GCACACCTTGTAATGCTAACCAG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e145bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-ACATCACTTTTATTAGCTTGTAATGTAG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-GCGAAGGTTGTCAATACTGATG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e127bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-CCTGCTTGCGACCACCATTC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-CACTAGCGCTAATATGCGTGAMAC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e175bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-GTCCACYACAGTAACAAACAACTG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-CAGACTAATWACATTAGGACATCC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e128bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[20]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-CAAACTTGTTAGGATCTGGTAACTG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-CTACAGCTCATTAACAGTGTAATAC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e136bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-CTGGATACTTACATACACTGCTAC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-GAATATGAATTACAATTTGTGTTTCAACTA-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e178bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[20]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-AGGTTATAGCTGCACTTTTCACATAT-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-TCTGAGGCACAGTTATTTAATAAACC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e142bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[20]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-CTGTAGCAGTACTAATAGTCATGTTAG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-ATGCTTATCTATGGATTATAAACAAACAC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e125bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-ATGGAGGACAATCAGTAGCAGCT-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-AATACCACTATTTTGGAGGATTGGAA-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e163bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[20]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-CAGGCCAAAACTTTAGTTTGTCATAAG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-CCTCCTCCCAGTTCTGTATATG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e167bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[20]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-GTRCTTCTGGTAGTATCCACAAC-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-CTCTGACTCCCAGTTATTTAACAAG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e149bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-TAGAGTCTGTAGTAGTGGACAATG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-ACTGCAACACCATCCAGTTGTG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e173bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[20]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-GTGCTTCTAGTAGTATCTACAACAG-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHPV type 82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eF: 5\u0026prime;-GTTATACAAGGTGGGGATTACTA-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e144bp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e[19]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eR: 5\u0026prime;-GKGACACTGGTGCAGGTGGTA-3\u0026prime;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 - Participants characteristic and HPV DNA association. (n=1018)\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"860\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic Variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPV DNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 96px;\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003cp\u003e(in Years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026gt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e4 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e10 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e21-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e95 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e18 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e77 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.505 (0.135- 1.885)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.309\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e31-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e413 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e66 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e347 (34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.452 (0.113- 1.537)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e41-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e360(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e54 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e306 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.405 (0.118-1.383)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e51-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e118 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e8(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e110 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.155 (0.038-0.632)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026lt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e16 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.259 (0.038-1.761)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 96px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e800(78.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e108(10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e692 (67.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eUnskilled worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e3.740 (0.582- 24.052)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eBusiness/private\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e45(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e36 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.769 (0.784- 3.991)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eEmployed in Government or Public Sector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e100 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e22(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e78(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.898 (1.035- 3.480)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eSelf employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e67(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e11 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e56 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.348 (0.658- 2.764)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 96px;\"\u003e\n \u003cp\u003eEducational Qualification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003ePrimary or below\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e12 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e10 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e71 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e19 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e52 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.458 (0.256-8.290)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e560 (55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e75 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e485 (47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.702 (0.139- 3.537)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.668\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e222 (21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e36 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e186 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.720 (0.141-3.679)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eGraduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e108 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e15 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e93 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.521(0.95-2.853)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003ePost graduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e45(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e5 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e40 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.414 (0.063-2.698)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 96px;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eUnmarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e68 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e10(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e58(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eReferencez\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e950 (93.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e142(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e808(79.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.989 (0.474- 2.064)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 96px;\"\u003e\n \u003cp\u003eBetel Nut consumption\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e171 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e19 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e152 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e495 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e61(5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e434 (42.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.615 (0.295- 1.283)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e352 (34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e72 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e280 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.847 (1.036- 3.293)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 96px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e465 (45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e405 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e60 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e333 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e287(28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e46 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.116 (0.455-2.738)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.811\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e220 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e174 (17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e46 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.434 (0.887-2.319)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 96px;\"\u003e\n \u003cp\u003eChewing tobacco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e276 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e237(23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e39 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e582 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e499(49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e83 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.069 (0.624-1.832)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e160 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e130(12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e30 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.159 (0.657- 2.043)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.610\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 96px;\"\u003e\n \u003cp\u003eAlcohol consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e648 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e94(9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e554 (54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e286 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e41(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e245 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2.182 (0.848-5.616)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.703\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e84 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e17(1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e67 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.154 (0.552-2.414)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e*Satistically significant ; Cl= Confident interval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 - Clinical Features and reproductive characteristic. (n=1018)\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"850\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPV DNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePost Menopausal Bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1010 (99.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e858 (84.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e152 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eVaginal Discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e152 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e97 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e55 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.093 (0.732-1.633)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.664\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e866 (85.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e557 (54.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e309 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCervicitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e271 (26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e240 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e31 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.841 (0.532-1.328)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e747(73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e626 (61.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e121 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCervics Polyps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e23 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e19(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.465 (0.458-4.689)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.520\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e995 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e847(83.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e148 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eBorderline Ovarian Tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e26 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e23 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.192 (0.337-4.215)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.785\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e992(97.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e843(82.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e149 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eVisual Inspection with Acetic Acid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e19(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.479 (0.371-5.897)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e996(97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e847 (83.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e149 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eOvarian Cyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e996 (97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e844(82.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e152(14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAdenomyosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e32 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e30 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.525 (0.119- 2.319)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e986 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e836 (82.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e150 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAbnormal Uterus bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e132 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e118(11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e14 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.841 (0.439-1.609)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e886 (87.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e748(73.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e138(13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eChronic Pelvic pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e142(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e107(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e35 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.112 (1.315-3.392)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e874 (85.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e759(74.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e117 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMenorrhagia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e48 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e40(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.381 (0.563-3.385)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.480\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e970 (95.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e826 (81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e144 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eGenital Ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.336 (0.814-23.107)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1009 (99.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e860(84.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e149 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDyspareunia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e18 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.388 (0.417-4.623)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e996(97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e848(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e148 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePoscoital bleeing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e14(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11(1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.815(0.430-7.663)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1004(98.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e855(83.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e149(14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSexually Transmitted Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.060 (0.115-9.803)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.959\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1011 (99.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e860(84.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e151(14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e39(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e31(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.317(0.554-3.133)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e979 (96.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e835(82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e144(14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e81 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e71(6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.130 (0.501-2.549)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e937(92.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e795(78.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e142(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 170px;\"\u003e\n \u003cp\u003eThyroid disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e18(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.962 (0.596-6.456)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e996 (97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e848(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e148(14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAge at first pregnancy in group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNulligravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026lt;20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e251(24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e206(20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e45(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e21 to 30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e648(63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e553(54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e95(9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026gt;30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e104(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e92(9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNumber of pregnancy in group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e36(3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e29(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eOnly 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e123(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e101(9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.496 (0.173-1.418)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eOnly 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e185 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e153(15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e32(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.503 (0.182-1.388)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e3 or more pregancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e674(66.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e583 (57.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e91(8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.352 (0.133-0.928)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.035*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAge of first intercourse in groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eLess than 15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e53 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e38(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e16 to 20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e216 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e176(17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e40(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.497 (0.229- 1.077)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e21 to 25 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e469(46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e411(40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e58(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.313 (0.137- 0.714)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e26 to 30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e169 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e142(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e27(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.315 (0.123-0.804)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.016*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e31 years and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e111 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e99(9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.268 (0.08- 0.871)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNumber of sexual partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eOne person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e906 (88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e773(75.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e133(13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMore than one\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e112(11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e93(9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e19(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.422 (0.788-2.568)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eIngestion of contraceptive pills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e436 (42.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e387(38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e48 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.604 (0.399-0.915)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e583(57.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e479(47.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e103(10.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 170px;\"\u003e\n \u003cp\u003eUse of Condom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e18(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4(0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.736 (0.208-2.599)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.634\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e999(98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e851(83.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e148 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 170px;\"\u003e\n \u003cp\u003eUse of Copper-T/Intrauterine Device (IUD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e37 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e31(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.015 (0.395-2.609)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.976\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e981 (96.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e835(82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e146(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e*Satistically significant ; Cl= Confident interval\u003c/strong\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HPV infection, cervical cancer, genotypic distribution, Mizoram, public health strategies","lastPublishedDoi":"10.21203/rs.3.rs-5795028/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5795028/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eHuman Papillomavirus (HPV), a major cause of cervical cancer, poses a significant public health challenge globally, with its burden amplified in regionsamidst limited access to screening and preventive measures\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eThis cross-sectional study investigates the prevalence of HPV infection and its associated risk factors among 1018 women from November 2023 to 2024 in Mizoram, India. The study integrates demographic, lifestyle, and clinical data, including DNA-based HPV genotyping and Pap smear analysis, to provide a comprehensive picture of HPV prevalence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThis study screened 1,018 women aged between 20 and 73 years for HPV, with a mean age of 41 years. Findings reveal a 14.9% overall prevalence of HPV infection where most participants were from Mizoram's Aizawl District (78.78%). Betel nut consumption and early sexual debut were key lifestyle factors associated with higher infection risks. Chronic pelvic pain and multiple pregnancies were significant clinical indicators. HPV-16 (26.97%) and HPV-18 (17.11%) were the most prevalent genotypes. About 23.4% exhibited multiple genotype infections. Pap smear results revealed associations with high-grade squamous intraepithelial lesions (p=0.025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe study underscores the importance of tailored public health strategies for high-risk regions like Mizoram. These include promoting HPV vaccination, enhancing screening programs, and addressing socio-cultural practices contributing to infection risks. Comprehensive interventions and awareness campaigns are crucial to mitigate the HPV burden and reducing cervical cancer incidence in this unique socio-demographic context.\u003c/p\u003e","manuscriptTitle":"Unveiling the Burden of Human Papillomavirus Infection and Risk Factors among indigenous Women in Mizoram, Northeast India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-13 17:33:31","doi":"10.21203/rs.3.rs-5795028/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"78add384-20d2-4d20-ba17-b30ae2c6c23b","owner":[],"postedDate":"January 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-04T01:08:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-13 17:33:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5795028","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5795028","identity":"rs-5795028","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}